内镜黏膜下剥离术治疗早期胃癌及高级别上皮内瘤变的疗效分析

摘要

Objective To investigate value of endoscopic submucosal dissection foRearly gastric canceR(EGC) and high-grade intraepithelial neoplasia (HGIN) using endoscopic submucosal dissection (ESD) and its risk factors influencing dissection.Methods The date of 80 patients who underwent ESD foREGC and HGIN in ouRhospital from DecembeR2012 to June 2014 were retrospectively reviewed.The clinical manifestation,endoscopic appearance and histopathological information were collected and the risk factors influencing curative resection afteRESD were analyzed.Results Among the enrolled 80 patients,the overall resection rate was 100%,the complete resection rate was 86.25% and the curative resection rate was 86.25%.The curative resection rate of the EGC group was significantly less than that of the HGIN group,(93.6% vs.75.76%,P<0.05).Single factoRanalysis revealed that patients with the following criteria were more likely to have higheRresection rate:a lesion size ≥2 cm,submucosa invasion and ulceration (P<0.05).Additional multivariate regression analysis demonstrated that submucosa invasion (OR=6.300,95% CI: 0.516-12.658,P<0.001),a lesion size ≥2 cm(OR=12.193,95% CI: 1.323～112.347,P=0.027) and ulceration(OR=5.679,95% CI: 1.087～29.678,P=0.040)were independent risk factors foRresection.Conclusion ESD is effective method foREGC and HGIN patients.Strictly evaluation and comprehensive treatment method are necessary foRsubmucosa invasion,lesion size ≥2 cm,and ulceration patients.%目的 探讨内镜黏膜下剥离术(ESD)治疗早期胃癌(EGC)及高级别上皮内瘤变(HGIN)的价值及影响其治愈性切除的因素.方法 回顾性分析2012年12月-2014年6月本院经ESD治疗的80例EGC及HGIN患者的临床病理资料,评估ESD治疗EGC及HGIN的效果,分析影响其治愈性切除的因素.结果 经ESD治疗的80例患者,整块切除率、完整切除率、治愈性切除率分别为100%、86.25%、86.25%.术后复发率为1.25%,3年生存率为98.75%.EGC组治愈性切除率为75.76%,显著低于HGIN组的93.6%(P<0.05).单因素分析显示,黏膜下层病变、病灶长径≥2 cm、溃疡形成的患者非治愈性切除比例相对更高(P<0.05).多因素分析结果显示,黏膜下层病变(OR=6.300,95% CI:0.516-12.658,P<0.001)、病灶长径≥2 cm(OR=12.193,95% CI:1.323～112.347,P=0.027)、溃疡形成(OR=5.679,95% CI:1.087～29.678,P=0.040)是胃黏膜早期肿瘤内镜非治愈性切除的危险因素.结论 ESD是治疗EGC及HGIN的有效方法.对于黏膜下层病变、病灶长径≥2 cm、溃疡形成的患者术前需严格评估,综合考虑治疗方案,以期获得治愈性切除效果.